Lorraine Smullen, expert in Embryology at The Hewitt Fertility Centre, who has been involved in the treatment of patients born in the 1950’s right through to the 1990’s, tells us about the changes she has seen in Embryology over the years.
When did your Embryology career begin?
In 1989, at the Royal Liverpool Hospital ACU, where the workforce was just 5, a much smaller team than the 130 we have today. I moved with the team from the ACU across to the Liverpool Women’s Hospital when the centre became the RMU in 1995, later to be renamed The Hewitt Fertility Centre. ‘Embryologist’ wasn’t a job title back then so we took on university posts initially.
What are the biggest differences you have seen in the lab?
The most significant change that has occurred in embryology was the introduction of double witnessing, in the beginning you were your only witness, whereas now every stage is verified by either a second embryologist or a radio frequency identity tag.
Media was made by us in the lab, we purified our own water and used plasma from each female patient’s blood collected two days prior to her egg collection, worlds away from now ordering in CE marked media from manufacturers. We also pulled our own pipettes over bunsen burners and used our mouths to pipette before tools called Bibijets were introduced.
We were limited to culturing embryos to day 2, and on this day we would ordinarily transfer 4 embryos. Multiple pregnancy rates were high at this time so we reduced this to 3 embryos, then to 2 when culture media was developed to culture embryos to day 3. Now culture media has allowed for culture to day 6 and following the HFEA ‘One at a time’ initiative to reduce multiple pregnancy rates, single embryo transfer is the most common practice.
What could you not be without now in the modern day lab?
ICSI (Intracytoplasmic sperm injection). Before this was introduced, IVF was the only option for all patients, all sperm samples were prepared by layering the sample underneath media, allowing the good sperm to swim up, we would then take the ‘hazy layer’ from the tube and mix this directly with the eggs. This was extremely frustrating when sperm quality was poor and therefore fertilisation rates were low.
Our lead consultant returned from an overseas conference telling us about an exciting new technique he had learned of, we jumped on board and ordered in an ICSI rig. Although again, we had to make our own needles for this in the beginning, I specifically remember one occasion spending so much time and care making a perfect holding pipette, then just as I had my eureka moment, I dropped it on the floor! Once manufactured pipettes were introduced we began to see fertilisation from ICSI and now this is routinely used for patients with poorer sperm samples.
What other revolutionary changes you have seen?
When freezing and thawing came in, this meant we could store surplus embryos of good quality and offer patients the option of frozen cycles. Most recently timelapse has been introduced where we can monitor embryo development via cameras within the incubators, not only meaning that the embryos are undisturbed until they are removed from the incubator for transfer or freezing, but also we have a wealth of information on each embryo and can use this as a selection tool for which embryo is best.
Finally, could you tell us one thing you miss from the old days?
Due to small patient numbers we would know every patient by name and enjoyed afternoon tea with them on the day’s in-between their appointments!
Many thanks to Lorraine for sharing her IVF memories with us for National Fertility Awareness Week 2017.